{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T12:43:00Z","timestamp":1793882580314,"version":"4.7.0"},"reference-count":351,"publisher":"American Medical Association (AMA)","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n \n Female sex has been identified as a risk factor for mortality in\n Staphylococcus aureus<\/jats:italic>\n bloodstream infection (SA-BSI). It is unknown whether this association extends to bloodstream infections with other bacterial species.\n <\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To investigate whether female sex is associated with increased mortality risk among patients with gram-negative bloodstream infection (GN-BSI).<\/jats:p>\n <\/jats:sec>\n \n Data Sources<\/jats:title>\n MEDLINE, Embase, and Web of Science were searched from inception to January 8, 2025.<\/jats:p>\n <\/jats:sec>\n \n Study Selection<\/jats:title>\n Study inclusion criteria were randomized or observational studies assessing adults with GN-BSI that included at least 100 patients and reported mortality at or before 90 days following GN-BSI, with mortality stratified by sex and, when applicable, by gram-negative bacterial species. Studies with polymicrobial GN-BSI were excluded. For inclusion in the primary analysis, studies must have stratified or statistically adjusted for confounding variables between female and male patients with GN-BSI. A secondary analysis included studies that reported sex-stratified unadjusted mortality.<\/jats:p>\n <\/jats:sec>\n \n Data Extraction and Synthesis<\/jats:title>\n One reviewer conducted extraction and quality assessment, which was verified by a second reviewer. Risk of bias and quality were assessed with the Newcastle-Ottawa Quality Assessment Scale. Mortality data were combined as odds ratios (ORs). The study followed the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measures<\/jats:title>\n Mortality at or before 90 days following GN-BSI, stratified by sex.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n From 9752 studies retrieved, 25 (16\u202f350 patients; 4017 female [25%], 12\u202f333 male [75%]) were included in the primary analysis. Female patients with GN-BSI did not have increased risk of mortality relative to male patients (pooled OR, 0.98 [95% CI, 0.81-1.17]). No publication bias was identified. Subset analyses based on medical comorbidities, timing of mortality end point, bacterial species group, antibiotic resistance phenotype, and publication date did not reveal a set of patients with differences in sex-stratified mortality. A total of 321 studies (147\u202f810 patients) that reported unadjusted mortality were included in a secondary analysis. In this analysis, female sex was associated with decreased risk of mortality (pooled OR, 0.90 [95% CI, 0.86-0.94]).<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this systematic review and meta-analysis, female patients with GN-BSI were not at higher risk than male patients of mortality after statistical adjustment. GN-BSI and SA-BSI thus differ in sex-specific mortality outcomes, highlighting the need for further research into the immunological, pathophysiological, and clinical management factors that may be associated with sex disparities in SA-BSI but not in GN-BSI.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.43552","type":"journal-article","created":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T16:00:50Z","timestamp":1763049650000},"page":"e2543552","source":"Crossref","is-referenced-by-count":3,"title":["Female Sex and Mortality in Patients With Gram-Negative Bacteremia"],"prefix":"10.1001","volume":"8","author":[{"given":"Priscilla","family":"La","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, Duke University School of Medicine, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Korn","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Duke University 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